液基细胞学检查与HPV检测在宫颈疾病筛查中的应用

Application of Thin Prep cytology test and HPV testing in cervical lesions screening

目的评价新柏氏液基细胞学检查(TCT)与高危型人乳头瘤病毒(HR-HPV)检测在宫颈疾病筛查中的应用价值。方法对1 890例在该院妇科门诊进行宫颈疾病筛查的患者,行TCT及杂交捕获二代(HC-2)HR-HPV检测,对其中TCT异常和(或)HR-HPV阳性者在电子阴道镜下行宫颈活检术,对照分析TCT、HR-HPV及病理检查结果。结果 (1)HR-HPV阳性率随着细胞学异常及宫颈上皮内瘤变(CIN)级别的增高而增加;病理学≥CINⅡ者HR-HPV感染率明显高于CINⅠ及以下病变者,差异有显著性(P<0.05)。(2)对≥CINⅡ病变(包括CINⅡ、CINⅢ及浸润癌),HR-HPV检测及TCT联合HR-HPV检测的敏感性均明显高于TCT检测,差异有显著性(P<0.05),但特异性均低于TCT检测(P<0.05)。TCT联合HR-HPV检测的敏感性略高于HR-HPV检测(92.5%vs 82.5%)。(3)无明确诊断意义的不典型鳞状细胞(ASCUS)病例中HR-HPV阳性组者≥CINⅡ病变的检出率明显高于阴性组(P<0.05)。结论 (1)HR-HPV检测是有价值的诊断技术,作为常规宫颈疾病筛查(细胞学检查)的一种辅助手段,有助于增加检查的灵敏度,提高宫颈癌及癌前病变的检出率,对防治宫颈癌有重要意义。(2)对TCT结果为ASCUS者,HR-HPV检测可起到有效的分流作用,避免因过度诊断和治疗给患者及医生造成负担,但需定期随访监测。

Objective To assess the application value of Thin Prep cytology test（ TCT） and high-risk HPV（ HR-HPV） testing in cervical lesions screening. Methods A total of 1890 women who took routine cervical screening in The First People＇s Hospital of Hefei all underwent the TCT and HR-HPV testing by the Hibrid Capture 2（ HC-2）. Patients with positive results of TCT and / or HR-HPV were performed colposcopy and histological examination on the cervical tissue. Cross-check analysis was made of the results of TCT,HRHPV and pathology examination. Results ①The positive rate of HR-HPV increased along with the developing grade of abnormal TCT and cervical intraepithelial neoplasia（ CIN） in patients. The HR-HPV infection rate of individuals with or = CINⅡ（ including CINⅡ,CINⅢ,carcinoma in situ and invasive cancer） was significantly higher than CINⅠ or lower（ P〈0. 05）. ②HR- HPV testing and TCT combined with HR- HPV testing were all substantially more sensitive in detecting 〉or = CINⅡ than TCT（ P〈0. 05） but less specific（ P〈0. 05）. The sensitivity of TCT combined with HR-HPV testing was slightly higher than HR-HPV testing in detecting 〉or = CINⅡ（ 92. 50% vs 82. 5%）.③Of the 105 cases with the cytological diagnosis of atypical squamous cell of undetermined significance（ ASCUS）,the pathologic diagnosis rate of or = CINⅡ in individuals with positive HR-HPV infection was significantly higher than in HRHPV negative group（ P〈0. 05）. Conclusions ①HR-HPV testing as an adjunct to conventional cytology in cervical lesions screening seems to increase detection sensitivity with proven cost-effectiveness. It can improve detectable rate of cervical cancer and precancerous lesions. It has important significance for prevention and cure of cervical cancer. ②HR-HPV testing is favorable for shunting management in patients with TCT showing as ASCUS,but they should receive the TCT and HR-HPV testing regularly.